What to Do if a Worker's Comp Claim is Denied?

Denied workers' compensation claims can be among the most disheartening experiences a worker will face. After all, they’re fighting for justice in an area that affects their financial well-being and quality of life.

It takes courage to go through this process — but it might not end with a denial. If you've had a workers' compensation claim denied, then there are a few remedial steps you can take to get the fair compensation you deserve.

This article will help you understand what to do when your workers' compensation claim is denied. For further inquiries about your claim, call our Chicago worker's compensation lawyer today!

Worker's Compensation

Workers' compensation is a system in the United States and many other countries that provide comp benefits to employees who are injured or become ill as a result of their job. In most cases, workers' compensation covers medical expenses and lost wages.

On average, it costs employers $957 a year per worker for legally required workers' compensation, as stated by the Bureau of Labor Statistics.

The vast majority of employers in the United States are required to carry workers' compensation insurance for their employees. However, not all types of injuries or illnesses are covered by workers' compensation. For example, if you are injured while on your lunch break, you would not be able to file a workers' compensation claim.

If you are injured or become ill as a result of your job, you should talk to your employer about filing a workers' compensation claim. The process of filing a claim can be complicated, so it is important to have an experienced comp attorney help you through the process.

During the compensation process, an employer or their insurance company ("Compensation Board") may deny your claim, perhaps the compensation terms are too high. This can be a devastating experience for a worker, especially if the injury or illness is serious.

Common Reasons For Workers' Comp Claims Denial

There are a variety of reasons for such denial. A Study was conducted to find out why workers' compensation claims are denied. The study showed that out of all the claims, 12.8% were either denied or still awaiting investigation. Thus, it is important to understand the primary reasons for a denied workers' compensation claim.

Some of the most common reasons include:

Discrepancies In Your Report

If your workers' compensation claim has been denied, one of the most common reasons is because of discrepancies in your report. This means that there are inconsistencies in the information you provided to the insurance company.

One of the best ways to avoid discrepancies in your report is, to be honest, and accurate when providing information to the insurance company. Make sure to provide all of the necessary information, including dates of injury, time periods, and names. If you are not sure what information to provide, ask a compensation attorney for help.

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Another way to avoid discrepancies in your report is to keep all of your documentation organized and up-to-date. Make sure to keep copies of all medical bills, wage statements, and other documentation related to your injury.

Waiting To Report the Injury

It is important to report an injury as soon as possible after it occurs. If you wait to report the injury, it may be more difficult to prove that the injury was caused by your job. In some cases, the insurance company may argue that the injury was caused by something else.

If you are injured, it is important to seek medical treatment right away. You should also report the injury to your employer as soon as possible. If you are unable to report the injury yourself, have a friend or family member report it for you.

It is also important to keep track of all of your medical bills and other documentation related to your injury. This information can help support your workers' compensation claim if it is denied.

Your Injury Isn't Covered

In some cases, an injured worker's claim for workers' compensation benefits may be denied because their injury is not covered. For example, if you are injured while on your lunch break, you would not be able to file a workers' compensation claim.

If you are injured or become ill as a result of your job, but your injury is not covered by workers' compensation, you may be able to file a personal injury claim. Personal injury claims are typically filed in civil court and can result in financial damages awarded to the injured party.

There Were Illegal Drugs In Your System

If your workers' compensation claim has been denied and you are told that one of the reasons is that there were illegal drugs in your system, you may be able to fight the denial.

Illegal drug use is not a valid reason for the denial of workers' compensation claims. If you can prove that you were not using drugs at the time of your injury, you may be able to have the denial overturned.

The Injury or Illness was Caused by the Employee's Own Negligence

If you are injured as a result of your own negligence, you will not be able to file a workers' compensation claim. This means that the injury was not caused by your job, but by something you did yourself.

If you are injured as a result of your own negligence, you may be able to file a personal injury claim. Personal injury claims are typically filed in civil court and can result in financial damages awarded to the injured party.

It is important to remember that an injury caused by your own negligence is not covered by workers' compensation.

The Injury is Not Considered Work-Related

If the injury or illness was not caused by the job, you will not be able to file a workers' compensation claim. This means that the injury was not caused by your job but by something else ("Off-site injury"). Workplace injury or workplace accident cases are generally catered for.

If you are injured as a result of something else, you may be able to file a personal injury claim. Personal injury claims are typically filed in civil court and can result in financial damages awarded to the injured party.

It is important to remember that an injury not caused by your job is not covered by workers' compensation.

Appealing Workers' Compensation Claim Denial

If your workers' compensation claim has been denied, you may be able to appeal the decision. An appeal is a formal request to have the decision reviewed by a higher authority.

There are several steps you can take to appeal a workers' compensation claim denial:

1. Gather all of your documentation related to the injury. This includes medical bills, wage statements, and other documentation related to your injury.
2. Speak with an attorney. An attorney can help you understand your rights and guide you through the appeals process.
3. File a petition for review with the Workers' Compensation Appeals Board. This petition must be filed within 60 days of the denial letter.
4. Attend a hearing with the Workers' Compensation Appeals Board. At the formal hearing, you will have an opportunity to present your case and argue why you should receive compensation benefits.
5. Appeal the decision if it is unfavorable. If the decision is unfavorable, you can appeal to a higher authority, such as a state court or the federal court system.

Key Steps After Workers' Compensation Claim is Denied

If your workers' compensation claim has been denied, you may be wondering what to expect in the appeals process. Here are some things you can expect:

1. You will need to gather all of your documentation related to the injury. This includes medical bills, wage statements, and other documentation related to your injury.
2. You should speak with an attorney. An attorney can help you understand your rights and guide you through the appeals process.
3. You will need to file a petition for review with the Workers' Compensation Appeals Board. This petition must be filed within 60 days of the denial letter.
4. You may be required to attend a formal hearing with the Workers' Compensation Appeals Board. At the hearing, you will have an opportunity to make your case and argument for why you should receive benefits.
5. If the decision is unfavorable, you have the option to appeal to a higher authority, such as a state court or the federal court system.

Timeline For Appeals

Appeals for denied workers' compensation claims can take several months, depending on the complexity of the case and the number of appeals filed. You should speak with an attorney who is familiar with your state’s laws to get a better idea of how long it may take to resolve your appeal.

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It is important to remember that the appeals process can take some time, so you should be prepared to wait for a resolution. You may also receive communication from the Workers' Compensation Appeals Board regarding your case during this period of time.

Conclusion

Denied workers' compensation claims can be a lengthy and complicated process. It is important to remember that an injury not caused by your job is not covered by workers' compensation. With patience and the help of an experienced personal injury attorney in Chicago, you can get through this difficult process and receive the compensation you deserve.

At Ktenas Injury Lawyers, our legal team is here to guide you through the legal process and help you achieve the best outcome. So, contact us today for a consultation, and let us handle your workers' compensation claim.